Individual
MKAYLA TAYLOR ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LBSW, BS
Contact information
Practice address
520 N 1ST ST, BLOOMFIELD, NM 87413-5307
(505) 634-3400
Mailing address
325 N BERGIN LN, BLOOMFIELD, NM 87413-6729
(505) 632-4300
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
SWB-2024-0680
NM
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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